Prior Approval

From 1 November 2023, Prior Approval should be obtained for any course of care and treatment where the cost exceeds or is likely to exceed £600.

The cost of treatment requiring Prior Approval excludes items within:

• Section 1 – Oral Health Examination and Diagnosis (except 1-(c)) and
• Section VIII – Domiciliary Visit and Recalled Attendance.

Prior Approval is no longer required for:

• Stabilising a tooth with a non-amalgam filling for patients who are pregnant, or are breastfeeding
• Posterior composite resin restorations involving the occlusal surface for patients who have an exceptional medical condition where there is a secondary care letter available
• Splints
• Internal bleaching

The following will still be subject to prior approval from 1 November 2023:

• Orthodontic (Item 32) items that require prior approval
• The miscellaneous balancing fee (item 39)- where an incomplete fee has been claimed prior to 1 November 2023 and the patient returns on or after 1 November 2023 to complete treatment

Prior approval submissions should contain appropriate information on the material proposed for direct and/or indirect restorations within the observations and any private treatment which is to be provided within the same or upcoming course of treatment.

Prior approval submissions regarding bridgework should contain information within observations regarding the design of the proposed bridgework including the relative abutment and pontic units. Information regarding the occlusion where bridgework is proposed should be included in observations.